Surveillance of Urothelial Carcinoma Stage and Grade Migration, 1993-2005 and Survival Trends, 1993-2000
Surveillance of Urothelial Carcinoma Stage and Grade Migration, 1993-2005 and Survival Trends, 1993-2000
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DOI：
10.1002/cncr.24147
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发表时间：
2009-04-01
期刊：
影响因子：
6.2
通讯作者：
Nanus, David M.
中科院分区：
文献类型：
--
作者：
David, Kevin A.;Mallin, Katherine;Nanus, David M.
背景：以前的研究人员发现肾细胞癌和前列腺癌的诊断转移到较低的阶段。作者调查了膀胱、输尿管和肾盆的尿路上皮癌是否存在类似的模式，并试图确定从1993年到2005年癌症级别和生存趋势的变化。方法：国家癌症数据库(NCDB)每年收集约75%的新诊断癌症病例的数据。作者查询了1993-2005年在18岁及以上患者中诊断的尿路上皮癌病例的数据库。所有癌症分期数据都被向前转换到第六版美国癌症分期定义联合委员会。结果：共确诊膀胱癌334,480例，肾盂癌15,105例，输尿管癌10,128例。84%的膀胱病例、83%的肾盂病例和82%的输尿管病例的分期数据可用。随着早期肿瘤分类为Oa、OIS和I期，晚期肿瘤分类为II、III和IV期，从1993年到2005年，早期肾盂和输尿管肿瘤的百分比略有增加，而膀胱肿瘤没有发现分期转移。在具体观察早期肿瘤时，在1993至2005年间，每个癌症部位的Oa期肿瘤比例显著增加，而I期肿瘤比例显著下降。从1993年到2005年，每个疾病部位的高级别肿瘤的比例显著增加。在1993-1996年和1997-2000年确诊的病例中，I期和II期膀胱癌患者的5年相对生存率显著下降。然而，绝对变化相对较小，在调整低级别或高级别肿瘤后，对于膀胱癌病例没有显著差异。结论：在区分早期和晚期肿瘤时，肾结石和输尿管癌有轻微的分期转移，而膀胱肿瘤则无分期转移。在所有部位的早期肿瘤中，都出现了分期转移，最明显的是Oa期肿瘤所占比例增加，而I期肿瘤所占比例减少。所有部位的高级别肿瘤所占比例均有所增加。总体存活率没有变化，强调了新的治疗进展的必要性。癌症杂志2009；115：1435-47。(C)2009年美国癌症协会。
BACKGROUND: Previous investigators have detected shifts to lower stages at diagnosis for renal cell carcinoma and prostate cancer. The authors investigated whether a similar pattern is seen for urothelial carcinomas of the bladder, ureter, and renal pelvis and sought to identify changes in cancer grade and survival trends from 1993 to 2005. METHODS: The National Cancer Data Base (NCDB) collects data on approximately 75% of all newly diagnosed cancer cases annually. The authors queried the database for cases of urothelial carcinomas diagnosed in 1993-2005 in patients aged 18 years and older. All cancer stage data were forward converted to the sixth edition of the American Joint Committee on Cancer staging definitions. RESULTS: A total of 334,480 bladder cancer cases, 15,105 renal pelvis cancer cases, and 10,128 ureteral carcinoma cases were identified. Stage data were available for 84% of bladder cases, 83% of renal pelvis cases, and 82% of ureter cases. With the classification of early stage tumors as stage Oa, Ois, and I and late stage tumors as II, III, and IV, the percentage of early stage renal pelvis and Ureter tumors increased slightly from 1993 to 2005, whereas no stage migration was seen in bladder tumors. In looking specifically at early stage tumors, a significant increase in the proportion of stage Oa and a significant decrease in the proportion of stage I tumors for each cancer site was seen between 1993 and 2005. The proportion of high grade tumors in each disease site significantly increased from 1993 to 2005. For cases diagnosed in 1993-1996 and 1997-2000, a significant decrease in 5-year relative survival was observed for patients with stage I and stage II bladder cancer. The absolute change, however, was relatively small, and for bladder cases was not significantly different when adjusted for low or high grade tumors. CONCLUSIONS: When differentiating between early and late stage tumors, a slight stage migration was seen in renal pelvis and ureteral carcinomas, whereas no stage migration was seen in bladder tumors. Within early stage tumors of all sites, a stage shift was seen, most notably with the proportion of stage Oa tumors increasing and stage I tumors decreasing. The proportion of high grade tumors in all sites increased. No change in overall survival was observed, underscoring the need for new therapeutic advances. Cancer 2009;115:1435-47. (C) 2009 American Cancer Society.